HomeMy WebLinkAboutHERITAGE PARK BLK 2 LT 15H Pitage PaPk Block 2 15 #050- 211 -6 § :' MUNICIPALITY OF ANCHORAGE , DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO¥~=CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ,~NEW [] ~T~G BAD E NAME MAILING ADDRESS LEGAL DESCRIPTION L©CATI©~ Well J~E~zJ ~// Absorption area Dwelling DISTANCE TO:I 'r~ //~1 I~-.~ . - mufacturer Material ~. cepec ty n gel ohs I ~ ....... Inside length Width mufacturer / ~,v Material Well /~A! / Foundation~ ,_.~ '~ Nearest lot line /.4~ Trench width Nd. priMes / grade 3 ! /1Matefial beneath tile I >7oTi.ches Topoft,etofinish 8'/' inche-": Length [ Depth: Type of crib Crib diameter Well DISTANCE TO: Class DISTANCE TO: Depth Building foundation NO. OF BE~DROOMS Crib depth Building foundation Sewer line PERMIT NO. ~ / No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines /,~ ~Fotal effective absorp,~J~n area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS ~T :, pv SOIL TEST RATING J./ /~, 'T,'T ~_~ REMARKS 2t'0/I/3 fRev. 3~78) DATE ~ Department~ ~ Health and Environments. ~rotect~on · , 825 4 Street, Anchorage, AK- ~9501 ~~/~~264_4720 ~-~ /~ * * * HANDWRITTEN PERMIT * * * Permit ~~'l~ ~ WELL AND/OR 0N-SITE SEWER PERMIT Applicant:~;~ ~ ~ ~ ~ Mailing Address: Location: Phone Number: Legal Description: Z ~ 7~/~ ~ ~~?~ Lot Size: Type of Soil Absorption System Is: Trench: ~/ Drainfield: Seepage Bed: Holding.Tank: Maximum Number of Bedrooms: ~-- Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is:' DEPTH [0 LENGTH ,~--/'0 ' GRAVEL DEPTH '"2 / WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTIC(HI:~TANK SIZE : /O~d:) GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may._. · , ~ __ , , ~require enlargement if the~ )/~residence is remodeled to include more that/3 D~ooms./ / / ~ SWP/024(1/81) [] MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION /(~ 925 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: ~q,3 LEGAL DESCRIPTION: . 1 2 3 4 5 6 7 8 9 10 11 12 13 16 17 18 19 20- COMMENTS PERFORMED 72-008 {6/79) WAS GROUND WATER ENCOUNTERED? .ATE PERFORMED: (~--Z'~ --'~ SLOPE SITE PLAN IF YES, AT WHAT DEPTH? FT AND ~/ FT CERTIFIE~ (minutes/inch} DATE: PERCOLATION RATE TEST RUN BETWEEN Gross Net Depth to Net Reading Date Time Time Water Drop /~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050,211-65 1. GENERAL INFORMATION Complete legal description Expiration Date: HERITAGE PARK BLOCK 2, LOT 15 Location (site address) 19509 LAURA LEE CIRCLE, EAGLE RIVER, 99577 Current Property owner(s) KENNY & MICHELLE SCHRAMKO Day phone Mailing address 19509 LAURA LEE CIRCLE, EAGLE RIVER, 99577 Lending agency Day phone Mailing address Real Estate Agent DAN WOLF - KW Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup, NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: IndiVidual Well Individual Water Storage Community Class__ Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [~ [] Individual Holding Tank [-'] [] Community On-site ~'] [] Public Sewer r--] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class G well and may be reissued with new water sample results. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the MUnicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(ara) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Pdnted Name KENNET~ M. DUFFUS Date 04/08/2011 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate dudng ~the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these vadous and dynamic characteristics and ara outside the control of the evaluator of the well and septic system. Therefore, AmTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE ~/' Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Attachments: 'COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: (Rev. 11/05) Original Certificate Date: /© Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.rnuni.org/onsite (9O7) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HERITAGE PARK BLOCK 2, LOT 15 Parcel ID: 050-211-65 A. WELL DATA Well type Iq. tBLIC If A, B, or C provide PWSID # Well:Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth f. Cased to f. Casing height (above ground) in. FROM WELL L/0~ AT INSPECTI,~/ Date of test / / Static water level / f. '/ lt. Well production / g.p.m. / . g.p.m. Coliform ~le'nies/lOOmL N~ mg/L Other~'eria _ co,~l'es/lO0 mL Arsemc. // mg/, Date of s,~f'ple: Collect,~o,: / B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/15/1983 Tank size 1000 gal, Number of Compartments _2 Cleanouts (Y/N) _.Y Foundation cleanout (Y/N) _Y. Depression over tank (Y/N) High water alarm (Y/N) N Date of pumping 4/6/2011 Pumper a-Rs C. ABSORPTION FIELD DATA Date installed 7/15/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 184 System type Trench Length 40 ff. Width 3 ft. Gravel below pipe 7__ff. Total depth 8.8 ft. (Measured 4/6/11) Eft. absorption area 752 fi2 Monitoring tube Y Depression over field N Date of adequacy test 4/6/2011 Results (Pass/Fail) Pass For 3__ bedrooms Fluid depth in absorp§on field before test [ in. Water added 610 gal. New depth Zl___in. Elapsed Time: 20 min. Final fluid depth 0_q_ in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo,) (Y/N & type) N If yes, give date __ D. UFT STATION Date installed /~ ~Pump on" level~ in. Datum ~ E. SEPARATION DISTANCES Size in gallons 'Pump off' level at ~ Cycles tested in. Manhole/Access ~ High water alarm~l at in. MeetS& cimuit requirement~'~ SEPARATION DISTANCES FROM/~ TO: Septic tank/lilt station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main ~ Public sewer manhole/~out Sewer/septic Service HOlding tank Animal containme~areas Manure/anim~'excrete'/' storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line $'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lois 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation IIY+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain $0'+ (None lCnown) Wells on adjacent lois 200'+ F. COMMENTS G. ENGINEER'S CERTIFICA~ON '~~-':.'~~ EngineeFs P~nted Name ~E~ M. D~S ~: Date ~08/2~1 ~~"':' '"':~ ~" . . . ....,:~ ~,,~.:. COSA Fee ~90.00 Waiver Fee $ Date of Payment / b - ~-- / / ~ ~ ~ ~ Date of Payment Receipt Number / ~ ~ ~ Receipt Number (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division ," . On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 www. muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Pamel I.D. 0-~'~' '~- I1- 6~ Expiration Date: t. GENERAL INFORMATION Complete legal description LOT 15; BLOCK 2; HERITAGE PARK Location (site address) 19509 LAURA LEE CIRCLE. EAGLE RIVER AK. 99577 COSA# oq 01 7 6; -.:30-/0 Current Property owner(s) JAMES L & DONNA L. BODKIN Day phone 694-4719 Mailing address 19509 LAURA LEE CIRCLE, EAGLE RIVER AK. 99577 Lending agency Mailing address Day phone Real_Estate_Ag~ _n_t Mailing Address Unless othen~ise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 Day phone 3. TYPE OF WATER SUPPLY: Individual Well [--J Individual Water Storage [] · Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAl..: Individual On-site [71 Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Ce~ficates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Ce~ificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with now water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or ;a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number cf bedrooms and typo of structure indicated herein. I further verify that based on the information obtained fi.om the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the lime of installation. Name of Firm s & s ENGINEERING Phone 694-2979 Address 15861 S. BIRCHWOOOLOOPRD. CHUGIA~AY,.99567 Engineer's Printed Name ROBERTA. SHAFER 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for __ bedrooms. bedrooms, with the following Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & ~/astewater Program 4700 Elm0re Street P.O. Box 196650 '- Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 Absorption rate >= CERTIFICATE OF ON-SITI~ :SYSTEMS APPROVAL CHECKLIST LegalDescription:LoJ,--I¢ glk2}_. /-Dr ,,-L. Parce,,D:O.5'O-..~l/-~....z'" A. WELL DATA '- WeIItype~,I.~I;.._._C.. IfA, B, orCprovidePWSID# "WellLog(Y/N) Date completed Sanitary seal (Y/N) Wires properly p Total depth ft. Cased to ft. Ca~ing hei~round) in. -' FROM WELL LOG AT IN..~TION Date of test Static water level ~. ft. ft. Well production g.p.m. WATER SAMP~ Coliform ~ colonies/100 mL Nitrate ,, mg/L Other bacteria __ colonies/100 mL ~ ug/L date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~ ~ p -~'"(.../$ '~[-c.~,I Date installed "7/~/~u'3 Tank size t 000 gal. Number of Compartments .~....- Cleanouts (Y/N) 7~ S' Foundation cie~nout (Y/N) ~/E.5 Depression over tank(Y/N) ~,,~O High water alarm (Y/N) ~,~O C. ABSORPTION FIELDOATA Date installed ~__~'"~ So,lrafing (gp.d./ft'(~"~-/8~'I Systemlype : · Length "7~ fl. Width ft. Gravel below pipe ~ ft. Total depth ( O ft. Eft. abso[l:)tion area"~ft;~ Monitoring tube ~-~ Depression over field : Date of adequacy test ~/' ~"/; '~ Results(Pass/Fail) '~ ['¢ ' For "~ bedrooms Fluid depth in absorption field before test.-`).-,. in. Water addedt~'0 gal, ' New depth ~'"' in. Elapsed Time: I~0 min. Final fluid depth ~ in. ff~O g.p.d. Any rejuvenation treatment (past 12 mo.) (Yin & type~ If yes, give date D. LIFT STATION Date installed ,'~//~ Size in gallons Manhole/Acces~ss~./_~ 'Pump on' level at in. ~er alarm level at in. ~__Datum ~Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION D STANCES FROM WELL ON LOT TO: Septic tanldlift station on lot On adjacent lots Absorption field on lot On~ Public sewer main / Public sewer manholelcleanout Sewer/septic s 'ervi~ Holding tank ~ment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~"~ Property line '~ I? Absorption field Water main ]O I.f Water service line. /(J ''f Surface water Wells on adjacent lots /oo sEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~/~ ~'f Building foundation lC, ~ Water main / 0 Water Service line. /~ ~ '~ Surface water ,* ~ o/~ Driveway, parking/vehicle storage. /O ~'~ Curtain drain ino~. k.,~.~ Wells on adjacent lots /'u e F. COMMENTS O. ENGINEER'S ~RTIF]CATION · I certify that I have determinedtl~eqgh field inspections review of Municipal records th~t'th~J~eboye sJ(ste, ms/are COSA Fee $ Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 15 '4 I MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSpEcTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 15; B~ock 2; Heritage Park Subdivision Location (address or directions) 19509 Laura Lee Circle (b) Property owner Ohesmore Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent R6 Kolfi~ld Address 16600 Centerfield Drive Max of Eagle RZver Eagle River, Ak. 99577 Telephone 694-4200 (e) Mail the HAA to the following address: (or check here [~)df hold for pick List contact person and day phone number below: ATTN: Virginia $ & $ ENGINEEI~iNG 17034 Eagle Ri.var Lo~.p-Road Eagle River, Alaska 2. TYPE OF RESIDENCE Single-Family E~X Number of bedrooms 5 ~ 3. WATER SUPPLY Individual Well [] Community ~ Public [] Note: If community well system, must have written confirmation from the State D~partment of Environmental Conservation attesting to th legality and status. ' ' 4. SEWAGE DISPOSAL On-site [~ Public [] Community [] Holding Tank [] Note: If community well system, mus~ have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Fir~q&._s ENG|,'~.TRh'4G 17034 Eagle River Loop Road No 20,~ Address ~--.,- ~,, ...... ,--, ...... ' - Date Telephone 6. DHHS APPROVAL Approved for '~ Approved ~, ' "Disapproved Conditional Date Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 {Rev. 7/88) Back Page 2 of 2 ~ ~u,; .~/IUNICIPALITY OF ANCHORAGE (MOA) (,e~r'~'~,5,O'- Health Authority Approval (HAA) · L~ CHECKLIST- FEBRUARY 1984 ~ ~ ~~ 343-4744 . ,-a ~-~" Lega Descr~pbon: .W L OATA Well GlasSificati~ ~ Dh If A, 8, G, D.E.G. Approved (Y/~) Well Log Present (Y/N) Total Depth. Cased to __ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test ReSults Comments ~ ~ ~_.-c~-~.-~ ; On Adjoining Lots 7./~.~ ~ -~- ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Date Installed "7~ ¢~ Size Standpipes ~N) ~ Depression over Tank (Y/~ pu mping/Maintenance Contact 0n File (y/N)~..~) r~l/~ ;for Holding Tank High-Water Alarm (Y/N) ~- Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: B. SEPTIC/HOLDING TANK DATA /F)OO No. of Compartments ~ Air-tight Caps ~N) ¥/ Foundation Cleanout ~)'N) Date Last Pumped / - ~"~ ~ / To Water-Supply Well -7.--,~'~ ~ Y- To Property Line J '~ ~ ~ To Water Main/Service Line ~. O~ ¥' To Stream, Pond, Lake or Major Drainage Course COm ments ~c-- ~:~0 c%~ r-~ To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '-'/ ~ ~)'~ Width of Field ~z:~ i~ Type of System Design Length of Field Depth of Field / Square Feet of Absortion Area -;B-'C,o ¢ Gravel Bed Thickness -'] Statndpipes Present ~/N) Depression over Field (Y(~ Aa/ Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ¢<)~ ~ 4-- To Building Foundation \ Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line \~\ To Existing or Abandoned System on ; On Adjoining Lots ,'"~u~. ~7' To Cutback (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On." Level at High Water Alarm Level at Tested for Dimensions .---- Manhole/Access (Y/~"~ "Pump~vel at ~ Vent (Y/N) -Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments J **CheclCPe-~mitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this. inspection. Signed 5 & ~ ,~.~,v..~ ~, N~. Company F~I~ t~Jver, &h~s~[a ~95~ Date ~*~ MOANo. ~' ¢~ ~ Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 APPLIC, ',IT FILLS OUT UPPER HAL ONLY ~..,,~. Zip Code ~. c; -- <-' - Buyer Address Zip Code Phone Address Zip Code / Phone Realty Co. & Agent Address Zip Code Street Locati~ Type of Resi~nce ingle Family ultiple Family No. of Bedrooms ~ Other Water Supply ¢ Individual A~ACH WELL LOG. A w¢l Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available),  Community Public Utility Sewer Disposal Year Individual Installed: lndividual Public Utility When Connected to Public Utility: ~ Holding Tank NOTE:'THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date ',L.' ~,Lt~'~ Inspector Inspector Inspector Inspector Field Notes: ~ *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rati.ng! Date Sewer Installed Well To Absorption,,,,..~ ~ ~Area Well Log Received tooo [ ~/"~ Well ,o Tank I.,.~,~ - Septic Tank Size 72-023 (3182) ADEQUACY TEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAO DESIGN SOIL TEST ON SiTE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK ROBERTA. SHAFER January 8, 1984 CIVIL ENGINEER 694-2979 Municipality of Anchorage Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Reference: Lot 15; Block 2: Heritage Park Subdivision This letter will certify that during an on-site inspection of the waste water disposal system located on the referenced property, that all the clean-outs were visible and equipped with adequate seals. This residence is also connected to a community water system. If we may be of further service, please do not hesitate to contact S~-~ere~y ~. ~ cc: MIT SRB 196X EAGLE RIVER, ALASKA 99577